Partnering with Local Hospitals and Public Health to Manage COVID-19 Outbreaks in Nursing Homes

Abstract

Background/objectives: Almost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges.

Design: Outbreak investigation.

Setting: Three NHs in southeast Michigan.

Participants: All residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system.

Methods: Upon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility-wide testing and the following intervention measures: cohorting of COVID-19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID-19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14-day outcomes.

Results: A total of 29 cases of COVID-19 were identified at three participating NHs. Nineteen cases of COVID-19 were identified through symptom-triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point-prevalence survey required hospitalization, and five were discharged home within 14 days.

Conclusion: Proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID-19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.

Keywords: COVID-19; SARS-CoV-2; nursing home; outbreak; pandemic.

Figure 1

The first confirmed case of COVID‐19 identified at NH 1, NH 2, and NH 3 occurred on April 3, March 23, and March 30, respectively. NH 1: Four COVID‐19 patients were tested and identified between April 2 and 7; point‐prevalence testing was conducted on April 7, with results available April 8 to 9, and six COVID‐19 patients were identified; one case from a sample obtained before point‐prevalence testing was identified on April 8; an additional COVID‐19 patient was identified through symptom‐triggered testing on April 16. NH 2: Three COVID‐19 patients were identified between March 23 and April 9; point‐prevalence testing was conducted on April 10, and three COVID‐19 patients were identified; an additional COVID‐19 patient was identified through symptom‐triggered testing on April 12. NH 3: Eight COVID‐19 patients were identified between March 30 and April 14; point‐prevalence testing was conducted on April 15, with results available the next day, one COVID‐19 patient was identified; an additional COVID‐19 patient was identified through symptom‐triggered testing on April 23.